Celebrating the Survivor’s Spirit
Kick Up Your Heels Relay Event
MUST BE POSTMARKED
by: April 6, 2012
Date of Event: April 14, 2012 at 9:00 am
Registration at Couch Park, Stillwater, OK
Registration starts at 8:00 am
I, by submitting this form acknowledge that participation in this relay is a potentially hazardous activity. I should not enter unless Iam medically able and properly trained. I also know that there will be a possibility of traffic on the course. I assume the risk of running in traffic. I also assume any and all other risks associated with participating in this event including, but not limited to falls,contact with other participants, the effects of the weather, medical conditions related to heat or hydration, and the condition of roads, all such risks being known and appreciated by me. Furthermore I agree to yield to all emergency vehicles. I also am fullyaware that wheels of any kind except baby strollers and competitive wheelchairs, animals and headphones are strictly prohibitedand I agree not to have them on the course. Furthermore, I agree not to go back onto the course after finishing. Knowing these facts,and in consideration of your accepting my entry, I hereby for myself, my heirs, executors, administrators or anyone else who mightclaim on my behalf, covenant not to sue, and to waive and release and discharge Wings of Hope Family Crisis Services, any and allrace sponsors, race officials, volunteers, local and state police, and all municipalities including any and all of their agents, employees,assigns or anyone acting for or on their behalf from any and all claims or liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of, my participating in this event. This release and waiver extends to allclaims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. The
further grants fullpermission to sponsors and or agents authorized by them to use any photographs, video tapes, motion pictures, recordings or anyother record of this event for any purpose. Application for minor accepted only with a parent or guardian signature.
Signature Month Day YearDate
checks, cashier’s checks
Make checks payable to:
Wings of Hope Family Crisis Services.
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